Venous Disease General Flashcards
CEAP
Contraindications to EVLT
Some authors have expressed concern that veins >12 mm have an increased risk for incomplete obliteration and target vein phlebitis, but several studies have shown that veins >12 mm have similar outcomes with regards to closure rate, complications, and clinical and quality of life improvement.
If the vein is just below the skin and cannot be pushed down with tumescent solution at least 1 cm below the surface, there could be problems with staining and thermal injury to the overlying skin.
If there is tortuosity within the vein, it might limit the ability to pass the catheter.
The duration of reflux in this scenario meets pathologic criteria (great than 0.5 seconds). The presence of acute thrombus within the GSV is a contraindication to endovenous ablation.
EHIT Grades
Riks of sclerotherapy
Post-sclerotherapy pigmentation results when hemosiderin staining of the dermis. It occurs in 11% to 80% of patients, but persists in only 1% to 2% at 1 year. Hemosiderin is an indigestible component of the hemoglobin degradation and its elimination may take years. Thrombi occur in all veins after sclerotherapy. Incisional draining these foci of blood 2 to 4 weeks after the therapy may help decrease hyperpigmentation. Telangiectatic matting is the new appearance of fine red telangiectasias thought to result as response to the injured vessels. It occurs in 5% to 75% of patients. Most resolve within a year, with less than 1% persisting. Cutaneous necrosis is caused by extravasation of a sclerosing agent, injection into a dermal arteriole, reactive vasospasm, or excessive cutaneous pressure created by compression. This occurs in less than 1% of patients. Deep venous thrombosis has been described after sclerotherapy, but is rare. It is thought to be related to higher doses of sclerosant in one treatment setting. Cutaneous nerve injury has been described but is rare.
Common cause of secondary lyphemdema
filiriasis
Stages of Lyphemdema
Stemmer’s sign
Stemmer’s sign is a thickened skin fold at the base of the second toe or second finger that is a diagnostic sign for lymphedema. Stemmer’s sign is positive when this tissue cannot be lifted but can only be grasped as a lump of tissue. It is negative when it is possible to lift the tissue normally. This is a condition where the skin often cannot be pinched due to excessive lymphedema.
What are the cutoff values in for duration of reflux in duplex of lower extremities?
1sec for Femoral and Popliteal veins
500ms for the other veins (Deep femoral, Saphenous, Tibial and perforator veins)
What is the most appropriate treatment for post thrombotic syndrome with venous leg ulcer?
Debriding the ulcer and Compression therapy of 40-50mmHg stockings
What are the CEAP classification?
classify the physical findings associated with chronic venous insufficiency.
Clinical
0 - No visible signs
1 - Telangiectasias or reticular veins
2 - Varicose veins
3 - Edema
4a - Pigmentation and/or eczema
4b - Lipodermatosclerosis and/or atrophy
5 - Healed venous ulcer
6 - Open venous ulcer
A - Asymptomatic
S - Symptomatic
Etiology
C - congenital
P - primary
S - secondary (post thrombotic)
Anatomy
S - superficial
P - Perforator
D - Deep
Pathophysiology
R - reflux
O - obstruction
R,O - reflux and obstruction
N - no venous pathophysiology identifiable
What is the risk factor most associated with progression of CEAP clinical class of patients with varicose veins and chronic venous insufficirncy?
Prior deep vein thrombosis
What are the typical swelling areas of the leg in venous insufficiency?
Swelling is limited to the foot and ankle.
What should be considered if all the leg is swollen?
Venous outflow obstruction and/or lymphedema.
What is the normal standing venous pressue?
90mmHg
What is the normal venous pressure after exercise?
30mmHg
